THE SUCCESSFUL reversal of cardiac arrest by cardiopulmonary resuscitation has been well documented. The controversal question of whether external or internal cardiac massage is more effective has still not been solved. Recent evidence favors the use of open-chest cardiac massage if appropriaate facilities are available and the patient has not responded to 10 to 15 minutes of closed-chest massage.1 Higher cardiac output with open-chest resuscitation has been shown in animals2 as well as man.3 The difference in part may be due to the lower mean arterial pressure obtained with external cardiac massage. With cardiac arrest and cessation of circulation, there is a sudden rise of venous pressure and a similar fall in arterial pressure so that the two equilibrate at 20 to 25 mm Hg.1 If cardiac output is to follow traditional pressure flow relationships (flow = pressure/resistance) the mean arterial pressure must be higher than 25
Falsetti HL, Greene DG. Technique of Compression in Closed-Chest Cardiac Massage. JAMA. 1967;200(9):793–795. doi:10.1001/jama.1967.03120220095023
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